Biomedical subjects

G J Dinant

Publications and source records attributed to G J Dinant.

At least 19 recordsLinked to original sources

PubMed2006

Prognostic factors and clinical outcome in acute lower respiratory tract infections: a prospective study in general practice.

BACKGROUND: Unrealistic expectations about illness duration are likely to result in reconsultations and associated unnecessary antibiotic prescriptions. An evidence-based account of clinical outcomes in patients with lower respiratory tract infection (LRTI) may help avoid unnecessary antibiotic prescriptions and reconsultations. OBJECTIVES: We aimed to identify clinical factors that may predict a prolonged clinical course or poor outcome for patients with LRTI and to provide an evidence-based account of duration of an LRTI and the impact of the illness on daily activities in patients consulting in general practice. METHODS: A prospective cohort study of 247 adult patients with a clinical diagnosis of LRTI presenting to 25 GPs in The Netherlands was carried out. Multivariable Cox regression analysis was used to identify baseline clinical and infection parameters that predicted the time taken for symptoms to resolve. A Kaplan-Meier curve was used to analyse time-to-symptom resolution. Clinical cure was recorded by the GPs at 28 days after the initial consultation and by the patients at 27 days. RESULTS: Co-morbidity of asthma was a statistically significant predictor of delayed symptom resolution, whereas the presence of fever, perspiring and the prescription of an antibiotic weakly predicted enhanced symptom resolution. The GPs considered 89% of the patients clinically cured at 28 days, but 43% of these nevertheless reported ongoing symptoms. Patient-reported cure was much lower (51%), and usual daily activities were limited in 73% of the patients at baseline, and 19% at final follow-up. CONCLUSIONS: The course of LRTI was generally uncomplicated, but the morbidity of this illness was considerable with a longer duration than generally reported, especially for patients with co-existent asthma. These results underline once again the importance of providing GPs with an evidence-based account of outcomes to share with patients in order to set realistic expectations and of enhancing their communication skills within the consultation.

Acute Disease↗

PubMed2006

The prevalence of intellectual disability in Limburg, the Netherlands.

BACKGROUND: Current changes in care philosophy and diversity in care arrangements caused the need for a new estimate of the number of people with intellectual disability (ID), based on recent data. Previous estimates were based on client registrations, which was thought unreliable at this time. This manuscript studies the question how many people with ID can be found in (part of) the Netherlands. METHODS: Identification of people with ID through a combination of general practice (GP) data bases and service registrations in the province of Limburg. RESULTS: The prevalence of people with ID appeared to be between 0.64% and 0.70%. About 0.21-0.27% were living with family or on their own; 55% of them did not use common ID services. CONCLUSION: Results are based on a combination of identification methods. Thirteen per cent of uncertain cases led to minimum and maximum estimates of the population. Limitations of the method and alternative ways of data collection are discussed.

Adolescent↗

PubMed2005

Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice.

OBJECTIVE: Incorrect and unnecessary antibiotic prescribing enhancing bacterial resistance rates might be reduced if viral and bacterial lower respiratory tract infections (LRTI) could be differentiated clinically. Whether this is possible is often doubted but has rarely been studied in general practice. STUDY DESIGN AND SETTING: This was an observational cohort study in 15 general practice surgeries in the Netherlands. RESULTS: Etiologic diagnoses were obtained in 112 of 234 patients with complete data (48%). Viral pathogens were found as often as bacterial pathogens. Haemophilus (para-) influenzae was most frequently found. None of the symptoms and signs correlated statistically significantly with viral or bacterial LRTI. Erythrocyte sedimentation rate >50 (odds ratio [OR] 2.3-3.3) and C-reactive protein (CRP) >20 (OR 2.1-4.6) were independent predictors for viral LRTI and bacterial LRTI when compared with microbiologically unexplained LRTI. CONCLUSION: Extensive history-taking and physical examination did not provide items that predict viral or bacterial LRTI in adult patients in daily general practice. We could not confirm CRP to differentiate between viral and bacterial LRTI.

Adult↗

PubMed2004

Antibiotic resistance of faecal Escherichia coli from healthy volunteers from eight developing countries.

OBJECTIVES: To determine the prevalence of antibiotic-resistant faecal Escherichia coli from adult volunteers from urban (U) areas in Kenya, Mexico, Peru and the Philippines, and non-urban (NU) locations in Curacao, Mexico, Venezuela, Ghana, Zimbabwe and the Philippines. METHODS: Faecal samples of adult volunteers (n=1290) were analysed in one laboratory for the presence of antimicrobial-resistant E. coli using Eosin Methylene Blue agar plates containing, respectively, ampicillin, oxytetracycline, cefazolin, ciprofloxacin, gentamicin, chloramphenicol and trimethoprim at breakpoint concentrations. RESULTS: The mean age of the volunteers was approximately 35 years; most of them were female. Ciprofloxacin resistance was in the range 1%-63%: the highest percentages were found in the urban populations of Asia and South America. In Peru and the Philippines (U and NU), the prevalence of gentamicin resistance was >20%. Cefazolin resistance was the highest in the urban Philippines (25%). Higher prevalences for ampicillin, oxytetracycline and trimethoprim were found for urban areas compared with non-urban ones of Asia, Africa and South America, respectively (P<0.05). CONCLUSIONS: In the populations studied, antibiotic resistance in faecal E. coli from adult volunteers was emerging for cefazolin, gentamicin and ciprofloxacin and was high for the older drugs ampicillin, oxytetracycline, trimethoprim and chloramphenicol.

Adolescent↗

PubMed2004

Fibrinogen levels in hypercholesterolemic smokers and non-smokers in relation to age and gender.

Elevated total cholesterol and plasma fibrinogen levels and smoking are risk factors for cardiovascular disease, whose inter-relationships are influenced by both gender and age. The aim of this study was to investigate the effect of smoking on fibrinogen levels in a hypercholesterolemic population subdivided on the basis of gender and age. The study included 492 hypercholesterolemic subjects, divided into four subpopulations: men and women, aged 26-49 and 50-66 years. Mean fibrinogen levels among smokers and non-smokers in the four subpopulations of this hypercholesterolemic cohort followed mean total cholesterol levels. Three subpopulations (men <50 years, men >/=50 years and women >/=50 years) showed differences in mean total cholesterol and fibrinogen values between smokers and non-smokers (total cholesterol 7.23+/-0.54 vs. 7.40+/-0.93 mmol/l and fibrinogen 2.79+/-0.48 vs. 3.23+/-0.72 g/l in men <50 years; total cholesterol 7.17+/-0.43 vs. 7.50+/-0.60 mmol/l and fibrinogen 3.11+/-0.44 vs. 3.68+/-0.66 g/l in men >/=50 years and 7.41+/-0.59 vs. 7.65+/-0.73 mmol/l and fibrinogen 3.29+/-0.61 vs. 3.58+/-0.71 g/l in women >/=50 years). These values correspond to a percentage difference between smokers and nonsmokers in total cholesterol and fibrinogen of 2.4% and 15.8% in men <50 years, 4.6% and 18.3% in men >/=50 years and 3.2% and 8.8% in women >/=50 years. All differences were significant ( P<0.05), except for total cholesterol in the younger men (<50 years). No differences between smokers and non-smokers were observed in the younger female group (<50 years). Except in the younger female group (<50 years), significant differences between smokers and non-smokers were also observed in the number of subjects exceeding the upper reference value of fibrinogen (>4.0 g/l), the highest percentage being found for the older women smokers (>/=50 years) (29%). In Conclusion, smoking elevates fibrinogen levels in hypercholesterolemic men (<50 years; >/=50 years) and older women (>/=50 years), but not in younger women (<50 years).

Adult↗

PubMed2004

Inter-observer variation in the interpretation of chest radiographs for pneumonia in community-acquired lower respiratory tract infections.

AIM: To assess inter-observer variation in the interpretation of chest radiographs of individuals with pneumonia versus those without pneumonia. MATERIALS AND METHODS: Chest radiographs of out-patients with a lower respiratory tract infection (LRTI) were assessed for the presence of infiltrates by radiologists from three local hospitals and were reassessed by one university hospital radiologist. Various measures of inter-observer agreement were calculated. RESULTS: The observed proportional agreement was 218 in 243 patients (89.7%). Kappa was 0.53 (moderate agreement) with a 95% confidence interval of 0.37 to 0.69. The observed positive agreement (59%) was much lower than for negative agreement (94%). Kappa was considerably lower, if chronic obstructive pulmonary disease was present (kappa = 0.20) or Streptococcus pneumoniae (kappa = -0.29) was the infective agent. CONCLUSION: The overall inter-observer agreement adjusted for chance was moderate. Inter-observer agreement in cases with pneumonia was much worse than the agreement in negative (i.e. non-pneumonia) cases. A general practitioner's selection of patients with a higher chance of having pneumonia for chest radiography would thus not improve the observer agreement.

Adolescent↗

PubMed2004

A cross-sectional study of postmenopausal women found an association between osteoporosis and past gastric surgery or oral corticosteroids.

OBJECTIVE: To determine the relationship between osteoporosis and the presence of specific and nonspecific medical conditions in postmenopausal women. To what extent is this relationship useful in detecting osteoporosis in daily general practice. STUDY DESIGN AND SETTING: Subjects were 1,684 postmenopausal women registered with 23 general practitioners. Multivariate logistic regression analysis was done with 52 disease variables and 24 biometrical and lifestyle variables, using BMD as the dependent variable. Bivariate analysis was performed to calculate their contribution to the risk of having osteoporosis. RESULTS: Having more than one disease was associated with a lower prevalence of osteoporosis. A positive association with the presence of osteoporosis was only found for the use of corticosteroids, gastric surgery, and cervical complaints. The risk for osteoporosis in the high risk category increased from 39 to 71% in women using oral corticosteroids, from 39 to 56% in women with a history of gastric surgery, and from 39 to 63% in women with cervical complaints. CONCLUSION: The clinical relevance of medical conditions for detecting osteoporosis is limited. However, all patients using oral corticosteroids and patients with a history of gastric surgery should be checked for the presence of osteoporosis. Cervical compaints in the high risk category was associated with osteoporosis.

Administration, Oral↗

PubMed2003

Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection.

BACKGROUND: Diagnostic tests enabling general practitioners (GPs) to differentiate rapidly between pneumonia and other lower respiratory tract infections (LRTIs) are needed to prevent increase of bacterial resistance by unjustified antibiotic prescribing. AIMS: To assess the diagnostic value of symptoms, signs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for pneumonia; to derive a prediction rule for the presence of pneumonia; and to identify a low-risk group of patients who do not require antibiotic treatment. DESIGN OF STUDY: Cross-sectional. SETTING: Fifteen GP surgeries in the southern part of The Netherlands. METHOD: Twenty-five GPs recorded clinical information and diagnosis in 246 adult patients presenting with LRTI. Venous blood samples for CRP and ESR were taken and chest radiographs (reference standard) were made. Odds ratios, describing the relationships between discrete diagnostic variables and reference standard (pneumonia or no pneumonia) were calculated. Receiver operating characteristic analysis of ESR, CRP, and final models for pneumonia was performed. Prediction rules for pneumonia were derived from multiple logistic regression analysis. RESULTS: Dry cough, diarrhoea, and a recorded temperature of > or = 38 degrees C were independent and statistically significant predictors of pneumonia, whereas abnormal pulmonary auscultation and clinical diagnosis of pneumonia by the GPs were not. ESR and CRP had higher diagnostic odds ratios than any of the symptoms and signs. Adding CRP to the final 'symptoms and signs' model significantly increased the probability of correct diagnosis. Applying a prediction rule for low-risk patients, including a CRP of < 20, 80 of the 193 antibiotic prescriptions could have been prevented with a maximum risk of 2.5% of missing a pneumonia case. CONCLUSION: Most symptoms and signs traditionally associated with pneumonia are not predictive of pneumonia in general practice. The prediction rule for low-risk patients presented here, including a CRP of < 20, can considerably reduce unjustified antibiotic prescribing.

Adolescent↗

PubMed2002

Relationship between smoking habits and low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides in a hypercholesterolemic adult cohort, in relation to gender and age.

Elevated total cholesterol, the related low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and smoking habits are risk factors for cardiovascular disease. The objective of this study was to investigate the influence of habitual smoking on these parameters in 492 hypercholesterolemic men and women, aged between 26 and 66 years. Relative differences between smokers and non-smokers in the mean values of total cholesterol, low-density and hig-density lipoprotein-cholesterol, and triglycerides were 2.2%, 5.5%, -8.1%, and 13.7%, respectively. These differences were statistically significant (P<0.04). Over the entire cohort, including men and women, age did not affect the mean values significantly, except for total cholesterol and triglyceride values in smoking women, which were significantly higher in women over 50 years than in the younger women (P=0.011 and P=0.004). In both men and women, regardless of smoking habits, 43%-59% of subjects exceeded the upper reference range value for low-density lipoprotein-cholesterol (4.9 mmol/l), while 38%-59% exceeded the upper reference range value for triglycerides (2.0 mmol/l) and 82%-91% had values below the lower reference range value for high-density lipoprotein-cholesterol (0.9 mmol/l for men, 1.2 mmol/l for women). Smoking habits hardly influenced the extent to which reference values were exceeded, except for low-density lipoprotein-cholesterol in all subjects (higher percentage for smokers, P=0.041). Similar results were obtained for age, except for triglycerides in smoking women, wich showed high values in 26% of women <50 years versus 50% of women > or = 50 years (P=0.026). In conclusion, smoking has an adverse effect on low-density and high-density lipoprotein-cholesterol, and triglycerides in a hypercholesterolemic population of men and women, regardless of age.

Adult↗

PubMed2002

Is roxithromycin better than amoxicillin in the treatment of acute lower respiratory tract infections in primary care? A double-blind randomized controlled trial.

OBJECTIVE: To assess the efficacy of roxithromycin relative to amoxicillin. STUDY DESIGN: We conducted a double-blind randomized controlled trial of oral 500 mg amoxicillin 3 times per day vs oral 300 mg roxithromycin once a day for 10 days. POPULATION: We included 196 adults who had presented to a general practitioner with lower respiratory tract infection (LRTI) and, in the physician's opinion, needed antibiotic treatment. OUTCOMES MEASURED: We measured clinical response after 10 and 28 days, defined in 4 ways: (1) decrease in LRTI symptoms; (2) complete absence of symptoms; (3) decrease in signs; and (4) complete absence of signs. Self-reported response included the decrease in symptoms and the time until resumption of impaired or abandoned daily activities on days 1 through 10, 21, and 27. RESULTS: Clinical cure rates after the completion of antibiotic treatment (10 days) were not significantly different for the 2 groups. After 28 days, the roxithromycin group showed no increase in cure rate as evidenced by the decrease in symptoms, indicating a significantly lower cure rate. However, this difference did not alter physicians' overall conclusion after complete follow-up that 90% of patients, regardless of age, had been effectively treated with either amoxicillin or roxithromycin. CONCLUSIONS: The surplus value of roxithromycin was not confirmed. Amoxicillin remains a reliable first-choice antibiotic in the treatment of LRTI in general practice.

Adult↗

PubMed2001

[Compliance of family physicians with the recommendations of 'Hearing Impairment' guideline by the Dutch College of General Practitioners in treatment of simulated paper cases of hearing loss].

OBJECTIVE: To assess the extent to which the practice of general practitioners (GPs) in dealing with adult hearing-impaired patients complies with the recommendations in the NHG standard on 'Hardness of hearing', one year after its publication. DESIGN: Descriptive. METHOD: Eight paper cases concerning hearing-impaired patients were presented to 10 GPs. The compliance of the GPs' approach with the NHG standard was recorded, and the differences found were motivated by the GPs. RESULTS: Compliance was low for 'anamnesis' (27%), reasonable for 'supplementary examination'--'audiography' (42%) and 'whispered voice test' (12%)--and 'evaluation' (65%), and high for 'physical examination' ('otoscopy' 82%). Adapted questioning for the purpose of establishing the case history was observed. The questioning was adapted in so far as it took into account the information that had already been obtained. 'Management' gave high scores for 'instruction' (85%) and 'referral' (72%). For mostly practical reasons, the whispered voice test, recommended in the NHG standard was scarcely used (12%) whereas the tuning fork tests, which are not advocated in the NHG standard, were often used (43%). CONCLUSION: For the aspects 'otoscopy', 'instruction' and 'referral' the GPs' practice reflected the recommendations contained in the NHG standard 'Hardness of hearing'.

Adult↗

PubMed2001

Risk factors for osteoporosis related to their outcome: fractures.

The aim of the study was to determine to what extent easy obtainable bone mineral density (BMD)-related risk factors are associated with the occurrence of fractures and to what extent changes in these determinants during a patient's lifetime are relevant. A cross-sectional population-based study was carried out on 4725 postmenopausal women, 50-80 years of age, registered with 23 general practitioners (GPs). The women were questioned and examined. BMD of the lumbar spine was measured using dual-energy X-ray absorptiometry (QDR-1000, Hologic). We analyzed the total population as well as a random sample of 1155 women for whom additional data were collected on recalled weight at age 20-30 years and on self-reported height. Body mass index (BMI) was estimated in two ways: (2) objective BMI [= measured weight/(measured height)2]; (2) recalled BMI [= recalled body weight at age 20-30/(self-reported height)2]. Fractures (dependent variable) were categorized as: (1) fractures sustained during the patient's lifetime; (2) fractures after the age of 50 years; (3) fractures that had occurred during the 5 years before BMD measurement took place. Multivariate stepwise backward and forward logistic regression analyses, using fractures as the dependent variable, were performed with all discrete and non-discrete variables (divided into quartiles). The relationship between the presence of osteoporosis and the presence of fractures was related to the changes in BMI (recalled BMI versus objective BMI). More advanced age, positive family history of fractures and BMD had a positive association with the presence of fractures. Low recalled BMI was a statistically significant predictor of 'fractures during the patient's lifetime' and of 'fractures after the age of 50'. Hysterectomy was associated with a higher prevalence of 'fractures during the patient's lifetime'. Perimenopausal complaints in the history seemed to be associated with a lower prevalence of 'fractures after the age of 50'. Moderate (and heavy) occupational exercise in the past were associated with the presence of fractures 'after the age of 50' and 'fractures during the past 5 years'. Sporting activities in the past showed a slightly positive relationship with the presence of 'fractures during the patient's lifetime' and 'fractures after the age of 50'. Bivariate analysis revealed that current smokers had not sustained significantly more fractures than current nonsmokers, but within the subgroup of current smokers, the prevalence of fractures was significantly higher among those women who had smoked for more than 35 years. Smoking was statistically significantly associated with early menopause. Early menopause was not statistically significantly related to the presence of osteoporosis but appeared to be statistically significantly associated with the prevalence of fractures in the age categories over 65 years. The absolute risks of sustaining one or more fractures ranged from 3% to 44%. Women in the lowest quartile of recalled and objective BMI were often osteoporotic (40%). In this category, women with normal BMD had a statistically significant lower fracture risk than osteoporotic women. Women with a possibly decreased BMI were most often osteoporotic and had sustained more 'fractures during the past 5 years' than expected. Women who had (probably) always been obese were less often osteoporotic and had a much lower fracture risk. It is concluded that decreased BMI is associated with a higher risk of developing fractures at an older age. Prevention of fractures should include fall prevention. In addition, in lean women treatment of low BMD is important.

Absorptiometry, Photon↗

PubMed2001

A placebo-controlled, double-blind, randomised trial of magnesium-pyridoxal-5'-phosphate-glutamate for hypercholesterolaemia and other clinical-chemical risk factors of cardiovascular disease in a primary care setting.

BACKGROUND: Lipid-lowering drugs are extensively used in primary care to reduce the risk of cardiovascular disease (CVD). Apart from high total cholesterol (TC), several other clinical-chemical variables are associated with the risk of CVD. Magnesium-pyridoxal-5'-phosphate-glutamate (MPPG) has been found to have a positive influence on TC levels and other clinical-chemical values in some selected populations. OBJECTIVE: To assess, in a general practice (GP) setting, the efficacy and clinical effectiveness of MPPG in the treatment of clinical-chemical risk factors for CVD. DESIGN: Randomised double-blind, placebo-controlled, clinical trial, lasting 12 months. PATIENTS: Adults (25-66 years) in an average Dutch village population with serum cholesterol levels between 7.0 mmol/l and 9.9 mmol/l. INTERVENTION: Subjects were assigned at random to treatment with MPPG (3 x 150 mg daily) or placebo. Clinical-chemical parameters were assessed at 1, 3, 6, 9 and 12 months (t1, t2, t3, t4, t5). Efficacy was measured at t2. Long-term effect (clinical effectiveness) was measured by combining the results at t2, t3, t4 and t5 (t2-5). OUTCOME MEASURES: TC (primary), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides, apolipoprotein-A1 (Apo-A1), apolipoprotein-B100 (Apo-B), fibrinogen and lipoprotein a [Lp(a), secondary]. RESULTS: No statistically significant differences in the efficacy and effectiveness of TC were found between the MPPG group and the placebo group. The same was demonstrated for the other clinical-chemical values, except for LDL-C (effectiveness, P = 0.04). CONCLUSIONS: Efficacy and effectiveness of MPPG are too poor to be of relevance for application as a lipid-lowering drug in GP.

Adult↗

PubMed2001

Do short cases elicit different thinking processes than factual knowledge questions do?

PURPOSE: To assess whether case-based questions elicit different thinking processes from factual knowledge-based questions. METHOD: 20 general practitioners (GPs) and 20 students solved case-based questions and matched factual knowledge-based questions while thinking aloud. Verbatim protocols were analysed. Five indicators were defined: extent of protocols; immediate responses; re-reading of information given in the stem or case after the question had been read; order of re-reading information, and type of consideration, i.e. 'true-false' type or 'vector', that is, a deliberation which has a magnitude and a direction. RESULTS: Cases elicited longer protocols than factual knowledge questions. Students re-read more given information than GPs. GPs gave an immediate response on twice as many occasions as students. GPs re-ordered the case information, whereas students re-read the information in the order it was presented. This ordering difference was not found in the factual knowledge questions. Factual knowledge questions mainly led to 'true-false' considerations, whereas cases elicited mainly 'vector' considerations. CONCLUSION: Short case-based questions lead to thinking processes which represent problem-solving ability better than those elicited by factual knowledge questions.

Education, Medical↗

PubMed2001

Barriers in the care of patients who have experienced a traumatic event: the perspective of general practice.

BACKGROUND: Previous research has indicated that GPs encounter barriers in the care of patients who have experienced a traumatic event. OBJECTIVES: The aims of the present study were to map barriers GPs encounter in the care of patients who experience a traumatic event and solutions for these barriers, and to estimate the influence of GP characteristics on the number of barriers experienced. METHODS: Telephone interviews were conducted among a sample of 500 Dutch GPs stratified by sex. Topics covered barriers in the care of victims of: accidents, incest in the past, ongoing physical or sexual abuse of adults, and ongoing physical or sexual abuse of children. RESULTS: The response rate was 44%. GPs are regularly confronted with patients who have experienced a traumatic event. GPs experience 10% barriers in care of patients who have difficulties getting over an accident, 13% in the care of incest victims, 16% in the care of adults who are physically or sexually abused, and 20% in the care of physically or sexually abused children. Most of the GPs recently updated their knowledge of care of victims of traumatic events, but still the majority feel in need of additional expert training. CONCLUSION: GPs experience the greatest number of barriers in the care of children who are abused. GP characteristics were not related to the number of barriers. However, seeing more victims was related to fewer barriers. To facilitate GP care of victims of traumatic events, GP training and continuing medical education should focus especially on skills education regarding the detection and initial treatment of traumatic events of ongoing physical or sexual abuse.

Accidents↗

PubMed2000

Screening for osteoporosis using easily obtainable biometrical data: diagnostic accuracy of measured, self-reported and recalled BMI, and related costs of bone mineral density measurements.

The aims of the present study were: to determine the diagnostic accuracy of objectively measured, self-reported and recalled body mass index (BMI) for osteoporosis and osteopenia; to determine the diagnostic costs, in terms of bone mineral density (BMD) measurements, per osteoporotic or osteopenic patient detected, using different BMI tests; and to determine the extent to which the results can be used within the framework of the current screening program for breast cancer in The Netherlands. Within the framework of a cross-sectional study on the prevalence of osteoporosis in the south of The Netherlands, 1155 postmenopausal women aged 50-80 years were asked for their present height and their weight at age 20-30 years. Subsequently their actual weight, height and BMD of the lumbar spine (DXA) were measured. The BMD cutoff was 0.800 g/cm2 for osteoporosis and 0.970 g/cm2 for low BMD (osteoporosis + osteopenia). After receiver operating characteristic analysis, age was cut off at 60 years and BMI at 27 kg/m2. Diagnostic accuracies of objectively measured, self-reported and recalled BMI were evaluated using predictive values (PV) and odds ratios. The resulting 'true positive' and 'false positive' rates were used to calculate diagnostic costs (i.e., DXA) for each osteoporotic patient or low-BMD patient detected. The prevalence of osteoporosis in the study population was 25%, that of low BMD 65%. Only the age-BMI tests 'age > or = 60, BMI < or = 27' showed PVs for osteoporosis (31-41%) and for low BMD (71-81%) that were higher than the prior probabilities for these conditions. Related odds ratios were 2.14-3.18 (osteoporosis) and 1.87-3.04 (low BMD). The objective BMI test detected 50% of the osteoporotic patients. Using the self-reported BMI test and the recalled BMI test, detection rates increased to 55% and 69%, respectively. Concomitant costs per osteoporotic patient detected rose by 24%. Detection of patients with a low BMD increased from 38% for objective BMI and 42% for self-reported BMI to 60% for recalled BMI. Related costs increased by 11%. If all women over 50 years of age (irrespective of their BMI) were to be referred for BMD measurement, costs per osteoporotic patient or low-BMD patient detected would be 304 and 116 Euros, respectively. Only in women over 60 years does a BMI below 27 kg/m2 provide a better prediction of the presence of osteoporosis or low BMD than could be expected solely on the basis of the relevant prevalences in postmenopausal women aged 50-80 years. If the use of BMI for the detection of osteoporotic or low-BMD patients is still considered, measuring weight and just asking for a person's height will do. Although age and BMI are the strongest risk factors for osteoporosis, they are of less significance when used for screening the population for osteoporosis. More research is needed before age and BMI can be included in any screening program. As regards practical considerations alone, measurements of BMD could be implemented within the screening program for breast cancer.

Absorptiometry, Photon↗

PubMed2000

Construction of an algorithm for quick detection of patients with low bone mineral density and its applicability in daily general practice.

OBJECTIVE: To construct a quick algorithm to detect patients with low bone mineral density (BMD) and osteoporosis and determine its applicability in daily general practice. DESIGN: Cross-sectional study in all 9107 postmenopausal women, aged 50-80, registered at 12 general practice centers. SUBJECTS AND MEASUREMENTS: All healthy women (5303) and 25% of the remaining group (943/3804) were invited to participate. Of 6246 invited women, 4725 (76%) participated. The women were questioned (state of health, medical history, family history, and food questionnaire) and examined [weight, height, body mass index (BMI), and BMD of the lumbar spine]. STATISTICS: Multivariable, stepwise backward and forward logistic regression analyses were performed, with BMD of the lumbar spine (L2-L4, cut-off points at 0.800 g/cm(2) for osteoporosis and 0.970 g/cm(2) for low BMD) as the dependent variable. An algorithm was constructed with those variables that correlated statistically significantly and clinically relevant with the presence of both osteoporosis and low BMD. RESULTS: The prevalence of osteoporosis was 23%, that of low BMD was 65%. Only three variables (age, BMI, and fractures) were statistically significant and clinically relevant correlated with the presence of both osteoporosis and low BMD. Age (OR 2.70 for osteoporosis and OR 1.77 for low BMD) and fractures during the past five years (OR 3.60 for osteoporosis and OR 2.85 for low BMD) were found to be the key predictors. From the algorithm the absolute risks varied from 9% to 51% for osteoporosis and from 48% to 84% for low BMD. The corresponding relative risks varied from 1.0 to 5.7 and from 1.0 to 1.8. CONCLUSIONS: Using an algorithm with age, BMI, and fracture history subgroups at high risk could be identified. However, in whatever combination, many women with osteoporosis could not be identified. Despite the differences in methods, we found predictors for osteoporosis which were comparable with the results of other cross-sectional studies, meaning that the first selection of patients at high risk for low BMD can be done adequately by both specialists and general practitioners.

Aged↗

PubMed1999

[Differences in incidence of (violent) traumatic events in the national registration systems, population surveys and studies from family practice; a review of literature].

OBJECT: Comparison of (cumulative) incidences of traumatic events from population surveys and registration systems as well as from studies in general practice. DESIGN: Literature study. METHOD: Literature searches were done about the frequencies of accidents, sudden death, physical and sexual abuse listed in electronic databases and relevant catalogs covering 1986-1998, after which more references were searched via the references found, going back to 1984. RESULTS: There were large discrepancies between frequencies found in the several studies, such as national registration systems (n = 4), surveys in the open population (n = 10) and studies in general practice (n = 4). The incidence (per 1000 persons per year) of physical abuse were 66, 2.7 and 1-3 for surveys in the open population, police and general practitioners' registration systems respectively. For sexual abuse the figures were 21, 0.025 and 0.2-2.9 respectively. Different definitions and methods were used in the studies. CONCLUSION: General practitioners are aware of only a fraction of what their patients experience.

Accidents↗